US20060149261A1 - Implant for reconstruction of joints - Google Patents
Implant for reconstruction of joints Download PDFInfo
- Publication number
- US20060149261A1 US20060149261A1 US11/367,386 US36738606A US2006149261A1 US 20060149261 A1 US20060149261 A1 US 20060149261A1 US 36738606 A US36738606 A US 36738606A US 2006149261 A1 US2006149261 A1 US 2006149261A1
- Authority
- US
- United States
- Prior art keywords
- joint
- implant
- spacer member
- bones
- bone
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
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Images
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
- A61L27/50—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
- A61L27/58—Materials at least partially resorbable by the body
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- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/562—Implants for placement in joint gaps without restricting joint motion, e.g. to reduce arthritic pain
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
- A61F2/4225—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for feet, e.g. toes
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
- A61B17/06166—Sutures
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- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
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- A61F2/02—Prostheses implantable into the body
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- A61F2/02—Prostheses implantable into the body
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
- A61F2002/30004—Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis
- A61F2002/30011—Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis differing in porosity
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30667—Features concerning an interaction with the environment or a particular use of the prosthesis
- A61F2002/307—Prostheses for animals
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/30721—Accessories
- A61F2002/30754—Implants for interposition between two natural articular surfaces
-
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/30756—Cartilage endoprostheses
- A61F2002/30757—Cartilage endoprostheses made of a sheet covering the natural articular surface, e.g. cap
-
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
- A61F2/30907—Nets or sleeves applied to surface of prostheses or in cement
- A61F2002/30909—Nets
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
- A61F2/4241—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers
- A61F2002/4256—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers for carpo-metacarpal joints, i.e. CMC joints
- A61F2002/4258—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers for carpo-metacarpal joints, i.e. CMC joints for trapezo-metacarpal joints of thumbs
-
- A—HUMAN NECESSITIES
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2210/00—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2210/0004—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof bioabsorbable
-
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0028—Shapes in the form of latin or greek characters
- A61F2230/0052—T-shaped
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0063—Three-dimensional shapes
- A61F2230/0069—Three-dimensional shapes cylindrical
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- A—HUMAN NECESSITIES
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0063—Three-dimensional shapes
- A61F2230/0071—Three-dimensional shapes spherical
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
- A61F2250/0023—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in porosity
- A61F2250/0024—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in porosity made from both porous and non-porous parts, e.g. adjacent parts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
- A61F2250/0081—Prosthesis for animals
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00365—Proteins; Polypeptides; Degradation products thereof
Definitions
- the present invention relates to an implant for reconstruction of joints, preferably of the hands and feet.
- arthrosis of the base of the thumb is initially treated with anti-inflammatory agents, local cortisone injections and various types of supports.
- surgical methods are employed.
- wear of the joints is preferably treated by an operation stiffening the joint.
- SE-B-457,962 describes an implantable prosthesis for completely or partially replacing a tendon, a ligament or a cruciate ligament.
- U.S. Pat. No. 6,007,580 further describes a prosthesis made of a biodegradable material, which prosthesis is intended to connect two bones.
- hallux rigidus which is a form of arthrosis of the base of the big toe and which mainly affects men and entails restricted mobility of the metatarso-phalangeal joint of the big toe. This means that the foot cannot be deployed in the normal way when walking, and that the person affected suffers pain when walking and an altered gait pattern with loss of speed.
- the abovementioned method with a bridging tendon graft means, in the case of treating arthrosis of the base of the thumb, that a bone, namely the trapezoid bone, is removed in its entirety, which means that the thumb is shortened by the order of 1 cm and that the short thumb muscles have an altered range of functioning. Moreover, the proximal end of the metacarpal loses its stability. In order to reduce the instability and avoid conflict with the navicular bone, a bridging graft is formed from a tendon. However, the technique does not mean that the metacarpal is completely stable. This, together with the shortening of the thumb, leads to permanent loss of thumb strength both in the key grip and the three-point grip.
- the present invention makes available an implant which is of the type set out in the introduction and which completely eliminates the abovementioned problems.
- the implant according to the invention is characterized in that least one spacer member is intended to be placed between the ends of the bones which are to be connected, one end of the spacer member being designed to form a joint surface against one of said bone ends, a joint-stabilizing connection is arranged to connect said bones, the spacer member is made of at least one tissue-compatible material, and the joint-stabilizing connection is intended, upon use of the implant, to extend in the longitudinal direction across the joint and in over at least one side of the two bones which are connected by the joint.
- the implant comprises a spacer member, direct contact between adjacent bones is avoided, and thus also the occurrence of pain caused by bone rubbing against bone.
- the material is porous, entirely or partly. This, in combination with a pore size permitting ingrowth of new biological tissue means that the implant according to the invention substantially recreates a functioning joint.
- the spacer member and the joint stabilizing connection are made of degradable material.
- joint-stabilizing connection is made in one piece with the spacer member.
- the degradable material consists of polyurethane urea.
- the degradable material consists of poly-L-lactide.
- the degradable material consists of polydiaxone (PDS).
- the degradable material consists of poly- ⁇ -hydroxybutyrate (PHB).
- the degradable material consists of chitin or chitosan or polysaccharide.
- the degradable material consists of collagen or protein.
- the material consists of polyuretan.
- the material consists of silicone.
- the material consists of polyethylene terephtalate (PET).
- the inventiontion is characterized in that the implant in its entirety in cross-section mainly has the form of a T, where the stem is said spacer member.
- the invention is characterized in that the spacer member includes a film-like element which is intended to serve as said joint surface.
- the spacer member comprises a degradable and tissue-compatible material in the form of foam, fibre or thread, which material is cast, knitted or woven or in some other way formed to give the desired three-dimensional structure.
- said connection consists of flexible thread-like elements.
- the invention is characterized in that the joint-stabilizing connection consists of flexible thread-like elements, that said thread-like elements have at least one portion on both sides of the centre line of the two bones, that opposite ends of each of said portions are anchored in the respective bone, and that said portions span the joint and are designed to prevent mutual pivoting of the bones in the lateral direction.
- the invention is characterized in that said thread-like elements comprise two portions which each connect the two bones, and that said portions are designed to intersect each other across the joint, as a result of which movements in more than one plane are permitted.
- said thread-like elements comprise two portions which each connect the two bones, and that said portions are designed to intersect each other across the joint, as a result of which movements in more than one plane are permitted.
- FIG. 1 shows a perspective diagrammatic view of a first illustrative embodiment of an implant according to the invention.
- FIG. 2 shows a cross section through an implant according to FIG. 1 arranged in a joint between two bones.
- FIG. 3 shows a section along the line III-III in FIG. 2 .
- FIG. 4 shows a cross section of an implant according to FIG. 1 arranged in a joint between two bones, in a modified way compared to FIG. 2 .
- FIG. 5 shows a perspective view of the bones in a hand and wrist.
- FIG. 6 shows a portion of the hand shown in FIG. 5 , with an implant according to FIG. 1 arranged in a joint at the base of the thumb.
- FIG. 7 shows a second illustrative embodiment of an implant according to the invention arranged in a joint between two bones.
- FIG. 8 shows a side view of the implant and bones according to FIG. 7 .
- FIG. 9 shows a view similar to FIG. 7 with an implant according to a third illustrative embodiment, slightly modified in relation to the embodiment according to FIG. 7 .
- FIG. 10 shows a side view of the implant and bones according to FIG. 9 .
- FIG. 11 shows a fourth illustrative embodiment of an implant according to the invention arranged in a joint between two bones.
- FIG. 12 shows a side view of the illustrative embodiment according to FIG. 11 .
- FIGS. 13 and 14 show two sizes of spacer bodies which are included in the implant according to the illustrative embodiments in FIGS. 7-12 and which are intended to form articular heads in a joint.
- FIGS. 15 and 16 show two sizes of spacer bodies which are included in the implant according to the illustrative embodiments in FIGS. 9 and 10 and which are intended to form articular sockets in a joint.
- FIGS. 17 and 18 show the structure of a spacer member in an implant according to a fifth embodiment.
- FIGS. 19 and 20 show, in longitudinal section, the structure of a spacer member in an implant according to a sixth embodiment.
- FIGS. 21 and 22 show the structure of a spacer member in an implant according to a seventh embodiment.
- the implant in the illustrative embodiment according to FIG. 1 has a T-shaped cross section with a spacer member 1 and two connection branches 2 , 3 which, during use of the implant, are intended to form a joint-stabilizing connection.
- the implant is cast in one piece.
- Suitable materials for the implant are polymers comprising urethane groups with hydrolyzable ester groups or polymers comprising urea and urethane groups with ester links which are hydrolyzable.
- a suitable starting material for the implant is linear block polymers comprising urea and urethane groups with hydrolyzable ester groups. Material of this type is described in Swedish Patent 505,703. The material according to this publication can be cast into forms of the type shown in FIG.
- a suitable material is a network polymer which essentially lacks urea groups.
- Material of this type is described in Swedish Patent 510,868.
- Implants made of said materials can also be formed by a combination of casting and knitting or weaving.
- a spacer member can be formed by casting the polymer in question on a reinforcement of the same material, which reinforcement can be designed as a hose or the like and intended to be engaged on a bone end.
- the implant according to the invention is intended to be used in the reconstruction of damaged joints in humans and animals.
- the geometric design and the mechanical properties are chosen in accordance with the intended purpose.
- the implant will temporarily replace the damaged joint and the time of degradation of the implant must exceed the time for formation of cartilage-like tissue in the spacer member and joint-stabilizing connective tissue for forming a joint-stabilizing connection.
- the implant is designed so that, during the rehabilitation period, it fulfils the intended joint functions with sufficient strength and mobility.
- This in combination with the fact that the spacer member is porous and has a pore size permitting ingrowth of new biological tissue, means, as has been mentioned above, that the implant according to the invention stimulates recreation of a functioning joint, at the same time as the implant is degraded.
- Material according to SE 505,703 and SE 510,868 is broken down by hydrolysis and thereafter eliminated from the body.
- the implant according to FIG. 1 has been arranged in a damaged joint, for example a finger joint, between two bones 4 , 5 .
- the spacer member 1 is arranged between the bone ends 6 , 7 of the respective bones, by which means direct contact between adjacent bone ends is prevented and pain caused by bone rubbing against bone is avoided.
- recesses 8 have been formed in the bones 4 , 5 and are intended to accommodate the joint-stabilizing connection formed by the branches 2 , 3 .
- the bone end 7 serves as an articular socket and the bone 5 , in the position shown in FIG. 2 , is pivotable in the direction of the arrow A about the temporary joint surface which is formed by the spacer member 1 .
- the implant is flexible but substantially non-stretchable during normal use, i.e. under the forces which occur when a finger joint is bent in a natural manner.
- the bone 5 can thus be bent from the position shown in FIG. 2 by the order of magnitude of 90° and back, but not clockwise from the position shown in FIG. 2 .
- the opposite surface of the spacer member is in contact with a bone end 6 serving as an articular head on the bone 4 , and the bone 4 can pivot correspondingly in relation to the bone 5 in the direction of the arrow B.
- the spacer member like the rest of the implant, is porous with a pore size which permits ingrowth of new cartilage tissue for continuous re-formation of a permanent joint.
- the pore size also permits ingrowth of joint-stabilizing connective tissue in the branches 2 , 3 of the implant, for continuous replacement of the temporary joint-stabilizing connection.
- Re-formation of new cartilage tissue for the spacer body takes something in the region of 11 ⁇ 2 to 2 years and the total degradation time for the temporary spacer body must therefore exceed this period of time.
- the connective tissue which replaces the temporary connection is re-formed in a shorter time than cartilage tissue, and it takes something in the region of six months to 11 ⁇ 2 years for connective tissue to completely re-form.
- the implant has been secured in the bones 4 , 5 by means of suture threads 9 which, as is shown in FIG. 3 , connect the branches 2 , 3 of the implant to the respective bones.
- FIG. 4 shows an alternative means of securing the implant according to FIG. 1 .
- grooves 10 for the branches 2 , 3 have been formed in the bones 4 and 5 , as can be seen from FIG. 4 .
- These branches which form a joint-stabilizing connection, have been secured in the bones 4 and 5 , respectively, by means of continuous screws 9 ′.
- an uninterrupted hard outer bone surface is obtained on both the bones 4 and 5 .
- FIG. 5 shows the bones of the hand from above, i.e. the back of the hand.
- the 1st metacarpal has been indicated by 12 and the trapezoid bone by 13 .
- Said joint condition namely arthrosis of the base of the thumb, occurs in the joint between the 1st metacarpal 12 and the trapezoid bone 13 .
- FIG. 6 shows how an implant according to FIG. 1 can be arranged between said bones 12 and 13 .
- a worn portion of the trapezoid bone 13 has been removed and the spacer member 1 has been arranged between this sectioned bone and the 1st metacarpal 12 .
- the spacer member 1 bears tightly on the surface of the sectioned bone.
- the branches 2 , 3 have been connected by means of suture threads 9 to the respective bones 12 and 13 in order to form a joint-stabilizing connection at the base of the thumb.
- FIGS. 7 and 8 show a second illustrative embodiment of an implant according to the invention arranged in a joint between two bones 4 and 5 , for example in a finger or a toe.
- a spacer member 14 is arranged in the joint between the two bones.
- This spacer member 14 is preferably made of the same material as the implant according to the first embodiment.
- the spacer member 14 of the type included in the implant according to FIGS. 7 and 8 is shown separately in FIGS. 13 and 14 .
- a spacer member of this type can be produced in different sizes and thicknesses.
- FIG. 13 shows a very thin spacer member 14
- FIG. 14 shows a very thick spacer member 14 .
- the necessary thickness of the spacer member varies in the range of 0.5 to 7 mm.
- the thickness of spacer bodies of the type shown in FIGS. 13 and 14 can preferably vary within wider limits.
- the spacer bodies 14 are provided with securing portions 15 which are expediently made of the same material as the rest of the spacer body.
- the securing portions 15 according to FIG. 13 are made for example as woven or knitted ligaments.
- the securing portions can consist of suture threads or some other degradable, preferably bio-erodable material.
- the securing portions 15 are used for anchoring the spacer member 14 on one of the bones.
- FIGS. 7 and 8 show diagrammatically how the securing portions 15 have been connected to the bone 4 by means of suture threads 9 .
- the implant according to FIGS. 7 and 8 includes a flexible thread-like element 16 which is intended to serve as a temporary joint-stabilizing connection.
- the thread-like element has a portion 17 , 18 on both sides of the centre line of the two bones, which portions extend in the longitudinal direction of the bone and over the joint.
- the thread-like element is made in one piece and extends with portions 19 and 20 through holes in the bones 4 , 5 , respectively.
- the bones 5 and 4 can be bent from the position shown in FIG. 8 in the direction of the arrows A and B, respectively.
- the thread-like element is made of a degradable, preferably bio-erodable material, preferably of a linear block polymer of the type which has been described above, and has further been designed with mechanical properties similar to a natural ligament within its natural range of movement. This means that the thread-like element has, at least within a normal ligament's range of functioning, similar mechanical properties but that beyond this range of functioning it may be overdimensioned compared to a normal ligament.
- the thread-like element 16 is flexible but substantially non-stretchable, which means that the bones 4 , 5 in the position shown in FIG. 8 cannot be bent about the joint in the direction counter to the arrows A and B, respectively.
- FIGS. 9 and 10 corresponds to a large extent to the embodiment according to FIGS. 7 and 8 . Corresponding details in said embodiments have been provided with the same reference numbers. What distinguishes the implant according to FIGS. 9 and 10 from the embodiment described in connection with FIGS. 7 and 8 is that a further spacer member 21 has been arranged against the bone end 7 of the bone 5 . Spacer members of this type and designed as an articular socket are shown separately in FIGS. 15 and 16 . In the same way as has been described in connection with FIG. 13 and 14 , the thickness of the spacer member can be varied within the same limits. Moreover, the spacer members designed as articular sockets are provided with securing members 15 which are intended to anchor the spacer body 21 on the bone 5 by means of suture threads 9 , as shown in FIGS. 7 and 8 .
- FIGS. 11 and 12 show a fourth illustrative embodiment of an implant according to the invention.
- This fourth embodiment differs from the illustrative embodiment shown in FIGS. 7 and 8 only with respect to the thread-like element.
- the thread-like element is made in one piece 16 and has portions 24 , 25 which extend through holes in the bones 4 and 5 . Since the thread portions 22 and 23 run more freely on one side of the bone compared to the embodiments described in connection with FIGS.
- the bones 4 and 5 can, in addition to the possibility of pivoting in the direction of the arrows A and B in FIG. 12 , also be pivoted in another plane, such as is indicated by the arrows C in FIG. 11 .
- FIG. 17 shows a knitted or otherwise formed network structure 26 made of a degradable material, preferably from said linear block polymers according to SE 505,703.
- Said structure has the shape of a hood and is intended to serve as reinforcement in an implant.
- the latter is formed by means of a degradable material, preferably in the form of polyurethane with hydrolyzable ester groups, being cast from outside onto the top of the hood. Said material is described in SE 510,868.
- FIG. 18 shows the finished spacer member after casting, intended to serve as an articular head in a joint, for example a finger joint.
- the cast-on material has been indicated by 27 in FIG. 18 .
- the network structure 26 forms a hose which strengthens the spacer body from the inside, and the network portion 28 protruding from the cast body 27 forms a hose portion which is intended to be engaged on a bone which is to be connected to an adjacent bone via the joint.
- a further purpose of the network structure besides that of serving as a strengthening means, is to create a high degree of friction against the bone and facilitate growth therein.
- the network structure 26 is also stable for sewing in upon fixation to the bone.
- FIG. 19 shows, in a similar way to FIG. 17 , a knitted or otherwise formed network structure 29 which is intended to form an outer reinforcement for a spacer member, which is intended to serve as an articular socket, i.e. as a complement to a spacer member of the type which has been described in connection with FIGS. 17 and 18 .
- the network structure 29 is provided with one or more securing portions 30 which are intended to be secured on the outside of a bone by means of suture thread or the like.
- the securing portion 30 can go all the way round or be made up of one or more securing portions.
- a degradable material preferably in the form of polyurethanes with hydrolyzable ester groups, is cast onto the inside of the network structure, as can be seen from FIG. 20 , for forming an articular socket.
- the cast-on material has been indicated by 31 in FIG. 20 .
- the purpose of the network structure according to FIG. 20 is the same as has been described in connection with FIG. 18 , i.e. to serve as reinforcement in the spacer member, create friction against the bone and facilitate growth in the bone.
- FIGS. 17 to 21 show relatively thin spacer members corresponding to the spacer members shown in FIGS. 13 and 15 .
- FIGS. 21 a and 21 b show a knitted or otherwise formed network structure 32 of the type which has been described in connection with FIG. 17 above.
- the network structure 32 differs from that shown in FIG. 17 in that the top 33 of the structure is condensed and in that the reinforcement in the top 33 has a depth which will substantially correspond to the thickness of the degradable material 34 , see FIG. 22 , which is cast from the outside and in across the depth of the network structure in the top 33 .
- the cast material 34 like the network structure is expediently made of polyurethanes with hydrolyzable ester groups.
- the actual spacer member in the embodiment according to FIG. 22 has a thickness which substantially exceeds the thickness of the spacer member according to FIG. 18 .
- the difference arises in the same way as the difference in size which has been described in connection with FIGS. 13 and 14 above.
- the network structure 32 fulfils the same purposes as have been described above in connection with FIGS. 17 to 20 .
- the network structure 32 has a substantial depth at the top 34 and in this area it will serve also as internal reinforcement in the cast-on material. It is important that the spacer member in a joint does not collapse under the pressures which arise during natural use of the joint, and instead the temporary spacer member must hold adjacent bone ends at a distance from each other. It is of course also important that the temporary spacer members are resistant to wear.
- FIGS. 17 to 22 are combined with a joint-stabilizing connection, for example in the form of flexible thread-like elements which have been described in connection with FIGS. 7 to 12 .
- the spacer member which can consist of a cast or spun and thereafter knitted or woven structure or an otherwise formed structure, can be provided, as has been described above, with strengthening threads of the same material as the rest of the structure or of another degradable and tissue-compatible material.
- Said strengthening threads can be arranged to form a reinforcement skeleton which is intended to give the structure stability without locking it.
- the strengthening threads can for example be arranged in a defined direction in order to afford increased strength in this direction.
- the reinforcement skeleton can consist of a shell which surrounds the rest of the structure.
- the reinforcement structure can also comprise strengthening threads in one or more defined directions.
- the invention is not restricted to implants of degradable materials.
- non-degradable materials are silicone and polyethylene terephtalate.
- the implant according to the invention can have different forms than have been described above. All corners of the in the figures schematically shown T-shaped implant are preferably rounded.
- the implant can be shaped as a plate with integrated fastening members or joint-stabilizing connections.
- the implant can have a sponge-like shape with integrated stabilizing connections.
- an implant arranged such that the shape of the implant is adapted to the anatomic shape when exposed to load.
- the joint-stabilizing connection can be designed in a different way than has been described above.
- the material of the spacer member can consists of polytetrafluoro ethylene (PTFE). Also the joint-stabilizing connection can be made in the same material. This material is generally known under the trade name TEFLON®.
Abstract
A spacer member (1) is intended to be placed between the ends of the bones which are to be connected, one end of the spacer member being designed to form a joint surface against one of the bone ends (6,7). A joint-stabilizing connection (2,3) is arranged to connect the bones. The spacer member (1) is made of at least one tissue-compatible material.
Description
- This application is a division of co-pending application Ser. No. 10/250,310, filed on Dec. 23, 2003. Application Ser. No. 10/250,310 is the national phase of PCT International Application No. PCT/SE02/00038 filed on Jan. 11, 2002 under 35 U.S.C. § 371, which claims priority of Swedish Application No. 0100127-0 filed Jan. 15, 2001. The entire contents of each of the above-identified applications are hereby incorporated by reference.
- The present invention relates to an implant for reconstruction of joints, preferably of the hands and feet.
- Primary wear, arthrosis, of the joints of the hands and feet, for example the carpometacarpal joints of the thumb, is a common condition, especially in middle-aged women. Investigations show that about 12% of all women and 8% of men in their fifties complain of pain at the base of the thumb. The incidence of wear of the big toe, hallux rigidus, is probably even greater. These conditions cause pain at rest and also load-related pain and they reduce mobility. In the hand, this leads to pain in various types of grips and thereby reduces the gripping strength.
- In the foot, wear causes pain when walking, with reduced mobility and freedom of movement in the persons affected.
- Today, arthrosis of the base of the thumb is initially treated with anti-inflammatory agents, local cortisone injections and various types of supports. At a more developed stage of arthrosis of the base of the thumb, surgical methods are employed. In younger men, and in middle-aged men in work, wear of the joints is preferably treated by an operation stiffening the joint.
- Today, in middle-aged and older women, the surgical method employed involves some form of bridging graft with a tendon. However, tendoplasty requires a long period of rehabilitation. The reduction in pain and the increase in mobility are only achieved after 6 to 9 months. Moreover, the persons involved have to live with a permanent loss of strength in the thumb grip.
- Various types of prostheses have also been produced, for example for treating arthrosis of the base of the thumb. They are made of titanium, steel, plastic, carbon or silicone. However, they fail after a short time on account of luxation of the joint. It has also been found that when carbon is used, the carbon fibre structure breaks down mechanically over time and the carbon fibre fragments tend to migrate within the body. U.S. Pat. No. 4,411,027 proposes surrounding the carbon fibre structure with a shell of a bioabsorbable polymer for the purpose of protecting the structure from external mechanical action and keeping the fragments in place, at least in the early stage of healing. However, it has been found that carbon fibre fragments from the prosthesis still migrate within the body.
- SE-B-457,962 describes an implantable prosthesis for completely or partially replacing a tendon, a ligament or a cruciate ligament. U.S. Pat. No. 6,007,580 further describes a prosthesis made of a biodegradable material, which prosthesis is intended to connect two bones.
- However, no suitable implant for reconstruction of joints has hitherto been proposed. Preconditions for such an implant to be able to function well are, first, that it must have properties, such as the requisite strength and mobility, allowing it to replace the functions of the damaged joint, and, second, that it is biocompatible, i.e. that the body is not poisoned or otherwise harmed by the implant. Joints are particularly complicated since they involve joint capsules, ligaments, cartilage and synovial fluid in order to permit natural joint movements.
- It has been stated above that joint damage at the base of the thumb is extremely common and represents a major problem and causes suffering and impaired function in those concerned.
- Another common problem is hallux rigidus, which is a form of arthrosis of the base of the big toe and which mainly affects men and entails restricted mobility of the metatarso-phalangeal joint of the big toe. This means that the foot cannot be deployed in the normal way when walking, and that the person affected suffers pain when walking and an altered gait pattern with loss of speed.
- The abovementioned method with a bridging tendon graft means, in the case of treating arthrosis of the base of the thumb, that a bone, namely the trapezoid bone, is removed in its entirety, which means that the thumb is shortened by the order of 1 cm and that the short thumb muscles have an altered range of functioning. Moreover, the proximal end of the metacarpal loses its stability. In order to reduce the instability and avoid conflict with the navicular bone, a bridging graft is formed from a tendon. However, the technique does not mean that the metacarpal is completely stable. This, together with the shortening of the thumb, leads to permanent loss of thumb strength both in the key grip and the three-point grip.
- As has been mentioned above, the prostheses which have hitherto been produced are not entirely satisfactory either. One reason is that known prostheses do not stabilize the proximal metacarpal, which means that the prosthesis dislocates.
- There has therefore long been a need for a solution to the abovementioned problems which would allow satisfactory reconstruction of damaged joints in humans and animals.
- The present invention makes available an implant which is of the type set out in the introduction and which completely eliminates the abovementioned problems.
- The implant according to the invention is characterized in that least one spacer member is intended to be placed between the ends of the bones which are to be connected, one end of the spacer member being designed to form a joint surface against one of said bone ends, a joint-stabilizing connection is arranged to connect said bones, the spacer member is made of at least one tissue-compatible material, and the joint-stabilizing connection is intended, upon use of the implant, to extend in the longitudinal direction across the joint and in over at least one side of the two bones which are connected by the joint.
- Since the implant comprises a spacer member, direct contact between adjacent bones is avoided, and thus also the occurrence of pain caused by bone rubbing against bone.
- By means of the arrangement of said spacer member and a joint-stabilizing connection it is possible to ensure that during the period of growth of new tissue the implant has the correct form and also appropriate strength and mobility.
- According to one embodiment of the invention the material is porous, entirely or partly. This, in combination with a pore size permitting ingrowth of new biological tissue means that the implant according to the invention substantially recreates a functioning joint.
- According to one preferred embodiment, the spacer member and the joint stabilizing connection are made of degradable material.
- According to a further embodiment the joint-stabilizing connection is made in one piece with the spacer member.
- According to one embodiment the degradable material consists of polyurethane urea.
- According to another embodiment the degradable material consists of poly-L-lactide.
- According to a further embodiment the degradable material consists of polydiaxone (PDS).
- According to another embodiment the degradable material consists of poly-β-hydroxybutyrate (PHB).
- According to another embodiment the degradable material consists of chitin or chitosan or polysaccharide.
- According to a further embodiment the degradable material consists of collagen or protein.
- According to a further embodiment the material consists of polyuretan.
- According to a further embodiment the material consists of silicone.
- According to a further embodiment the material consists of polyethylene terephtalate (PET).
- According to another embodiment the inventiontion is characterized in that the implant in its entirety in cross-section mainly has the form of a T, where the stem is said spacer member.
- According to one embodiment the invention is characterized in that the spacer member includes a film-like element which is intended to serve as said joint surface.
- One embodiment of the invention is characterized in that the spacer member comprises a degradable and tissue-compatible material in the form of foam, fibre or thread, which material is cast, knitted or woven or in some other way formed to give the desired three-dimensional structure.
- According to one embodiment, said connection consists of flexible thread-like elements.
- According to one embodiment, the invention is characterized in that the joint-stabilizing connection consists of flexible thread-like elements, that said thread-like elements have at least one portion on both sides of the centre line of the two bones, that opposite ends of each of said portions are anchored in the respective bone, and that said portions span the joint and are designed to prevent mutual pivoting of the bones in the lateral direction.
- According to a further embodiment, the invention is characterized in that said thread-like elements comprise two portions which each connect the two bones, and that said portions are designed to intersect each other across the joint, as a result of which movements in more than one plane are permitted. When an implant according to this embodiment is arranged for reconstruction of a joint at the base of the thumb, the thumb can be moved in a more natural way during the healing process, which in turn means that growth of new tissue is stimulated, permitting an improved joint function for the thumb.
- Further preferred embodiments are set out in the attached patent claims.
- The invention will be described in more detail below with reference to illustrative embodiments which are shown in the attached drawing, where:
-
FIG. 1 shows a perspective diagrammatic view of a first illustrative embodiment of an implant according to the invention. -
FIG. 2 shows a cross section through an implant according toFIG. 1 arranged in a joint between two bones. -
FIG. 3 shows a section along the line III-III inFIG. 2 . -
FIG. 4 shows a cross section of an implant according toFIG. 1 arranged in a joint between two bones, in a modified way compared toFIG. 2 . -
FIG. 5 shows a perspective view of the bones in a hand and wrist. -
FIG. 6 shows a portion of the hand shown inFIG. 5 , with an implant according toFIG. 1 arranged in a joint at the base of the thumb. -
FIG. 7 shows a second illustrative embodiment of an implant according to the invention arranged in a joint between two bones. -
FIG. 8 shows a side view of the implant and bones according toFIG. 7 . -
FIG. 9 shows a view similar toFIG. 7 with an implant according to a third illustrative embodiment, slightly modified in relation to the embodiment according toFIG. 7 . -
FIG. 10 shows a side view of the implant and bones according toFIG. 9 . -
FIG. 11 shows a fourth illustrative embodiment of an implant according to the invention arranged in a joint between two bones. -
FIG. 12 shows a side view of the illustrative embodiment according toFIG. 11 . -
FIGS. 13 and 14 show two sizes of spacer bodies which are included in the implant according to the illustrative embodiments inFIGS. 7-12 and which are intended to form articular heads in a joint. -
FIGS. 15 and 16 show two sizes of spacer bodies which are included in the implant according to the illustrative embodiments inFIGS. 9 and 10 and which are intended to form articular sockets in a joint. -
FIGS. 17 and 18 show the structure of a spacer member in an implant according to a fifth embodiment. -
FIGS. 19 and 20 show, in longitudinal section, the structure of a spacer member in an implant according to a sixth embodiment. -
FIGS. 21 and 22 show the structure of a spacer member in an implant according to a seventh embodiment. - The implant in the illustrative embodiment according to
FIG. 1 has a T-shaped cross section with aspacer member 1 and twoconnection branches FIG. 1 or spun into fibres which are then knitted or woven and shaped to give the desired finished product. Another suitable material is a network polymer which essentially lacks urea groups. Material of this type is described in Swedish Patent 510,868. Implants made of said materials can also be formed by a combination of casting and knitting or weaving. For example, a spacer member can be formed by casting the polymer in question on a reinforcement of the same material, which reinforcement can be designed as a hose or the like and intended to be engaged on a bone end. By choosing their structure and the molecular chains involved, and by adding various substances, the materials of said types described in said Swedish Patents 505,073 and 510,868 can be controlled with respect to their mechanical properties and also with respect to their degradation time. - The implant according to the invention is intended to be used in the reconstruction of damaged joints in humans and animals. The geometric design and the mechanical properties are chosen in accordance with the intended purpose. The implant will temporarily replace the damaged joint and the time of degradation of the implant must exceed the time for formation of cartilage-like tissue in the spacer member and joint-stabilizing connective tissue for forming a joint-stabilizing connection. The implant is designed so that, during the rehabilitation period, it fulfils the intended joint functions with sufficient strength and mobility. This, in combination with the fact that the spacer member is porous and has a pore size permitting ingrowth of new biological tissue, means, as has been mentioned above, that the implant according to the invention stimulates recreation of a functioning joint, at the same time as the implant is degraded. Material according to SE 505,703 and SE 510,868 is broken down by hydrolysis and thereafter eliminated from the body.
- In
FIG. 2 , the implant according toFIG. 1 has been arranged in a damaged joint, for example a finger joint, between twobones spacer member 1 is arranged between the bone ends 6, 7 of the respective bones, by which means direct contact between adjacent bone ends is prevented and pain caused by bone rubbing against bone is avoided. Before the implant has been fitted, recesses 8 have been formed in thebones branches bone end 7 serves as an articular socket and thebone 5, in the position shown inFIG. 2 , is pivotable in the direction of the arrow A about the temporary joint surface which is formed by thespacer member 1. The implant is flexible but substantially non-stretchable during normal use, i.e. under the forces which occur when a finger joint is bent in a natural manner. Thebone 5 can thus be bent from the position shown inFIG. 2 by the order of magnitude of 90° and back, but not clockwise from the position shown inFIG. 2 . The opposite surface of the spacer member is in contact with abone end 6 serving as an articular head on thebone 4, and thebone 4 can pivot correspondingly in relation to thebone 5 in the direction of the arrow B. The spacer member, like the rest of the implant, is porous with a pore size which permits ingrowth of new cartilage tissue for continuous re-formation of a permanent joint. The pore size also permits ingrowth of joint-stabilizing connective tissue in thebranches - In the illustrative embodiment shown in
FIGS. 2 and 3 , the implant has been secured in thebones suture threads 9 which, as is shown inFIG. 3 , connect thebranches - In the illustrative embodiment shown in
FIG. 4 , details corresponding to similar ones in the illustrative embodiment according toFIGS. 2 and 3 have been provided with the same reference numbers. Compared toFIGS. 2 and 3 ,FIG. 4 shows an alternative means of securing the implant according toFIG. 1 . Instead of therecess 8,grooves 10 for thebranches bones FIG. 4 . These branches, which form a joint-stabilizing connection, have been secured in thebones continuous screws 9′. In the method according toFIG. 4 , an uninterrupted hard outer bone surface is obtained on both thebones - As was stated in the introduction, primary wear, for example in the carpometacarpal joints of the thumb, is a common type of condition which causes degradation and attrition of joint cartilage.
FIG. 5 shows the bones of the hand from above, i.e. the back of the hand. In the drawing, the 1st metacarpal has been indicated by 12 and the trapezoid bone by 13. Said joint condition, namely arthrosis of the base of the thumb, occurs in the joint between the1st metacarpal 12 and thetrapezoid bone 13. -
FIG. 6 shows how an implant according toFIG. 1 can be arranged between saidbones trapezoid bone 13 has been removed and thespacer member 1 has been arranged between this sectioned bone and the1st metacarpal 12. Thespacer member 1 bears tightly on the surface of the sectioned bone. Thebranches suture threads 9 to therespective bones -
FIGS. 7 and 8 show a second illustrative embodiment of an implant according to the invention arranged in a joint between twobones spacer member 14 is arranged in the joint between the two bones. Thisspacer member 14 is preferably made of the same material as the implant according to the first embodiment. Thespacer member 14 of the type included in the implant according toFIGS. 7 and 8 is shown separately inFIGS. 13 and 14 . A spacer member of this type can be produced in different sizes and thicknesses.FIG. 13 shows a verythin spacer member 14, andFIG. 14 shows a verythick spacer member 14. For joints in the hands and feet, the necessary thickness of the spacer member varies in the range of 0.5 to 7 mm. For joints in animals, the thickness of spacer bodies of the type shown inFIGS. 13 and 14 can preferably vary within wider limits. Thespacer bodies 14 are provided with securingportions 15 which are expediently made of the same material as the rest of the spacer body. The securingportions 15 according toFIG. 13 are made for example as woven or knitted ligaments. Alternatively, the securing portions can consist of suture threads or some other degradable, preferably bio-erodable material. The securingportions 15 are used for anchoring thespacer member 14 on one of the bones.FIG. 7 shows diagrammatically how the securingportions 15 have been connected to thebone 4 by means ofsuture threads 9. The implant according toFIGS. 7 and 8 includes a flexible thread-like element 16 which is intended to serve as a temporary joint-stabilizing connection. As can be seen fromFIGS. 7 and 8 , the thread-like element has aportion portions bones - As in the embodiment according to
FIGS. 2 and 3 , thebones FIG. 8 in the direction of the arrows A and B, respectively. The thread-like element is made of a degradable, preferably bio-erodable material, preferably of a linear block polymer of the type which has been described above, and has further been designed with mechanical properties similar to a natural ligament within its natural range of movement. This means that the thread-like element has, at least within a normal ligament's range of functioning, similar mechanical properties but that beyond this range of functioning it may be overdimensioned compared to a normal ligament. The thread-like element 16 is flexible but substantially non-stretchable, which means that thebones FIG. 8 cannot be bent about the joint in the direction counter to the arrows A and B, respectively. - A third illustrative embodiment according to
FIGS. 9 and 10 corresponds to a large extent to the embodiment according toFIGS. 7 and 8 . Corresponding details in said embodiments have been provided with the same reference numbers. What distinguishes the implant according toFIGS. 9 and 10 from the embodiment described in connection withFIGS. 7 and 8 is that afurther spacer member 21 has been arranged against thebone end 7 of thebone 5. Spacer members of this type and designed as an articular socket are shown separately inFIGS. 15 and 16 . In the same way as has been described in connection withFIG. 13 and 14, the thickness of the spacer member can be varied within the same limits. Moreover, the spacer members designed as articular sockets are provided with securingmembers 15 which are intended to anchor thespacer body 21 on thebone 5 by means ofsuture threads 9, as shown inFIGS. 7 and 8 . -
FIGS. 11 and 12 show a fourth illustrative embodiment of an implant according to the invention. This fourth embodiment differs from the illustrative embodiment shown inFIGS. 7 and 8 only with respect to the thread-like element. This has been arranged withthread portions bones FIGS. 11 and 12 . The thread-like element is made in onepiece 16 and hasportions bones thread portions respective thread portions bones FIG. 12 , also be pivoted in another plane, such as is indicated by the arrows C inFIG. 11 . -
FIG. 17 shows a knitted or otherwise formednetwork structure 26 made of a degradable material, preferably from said linear block polymers according to SE 505,703. Said structure has the shape of a hood and is intended to serve as reinforcement in an implant. The latter is formed by means of a degradable material, preferably in the form of polyurethane with hydrolyzable ester groups, being cast from outside onto the top of the hood. Said material is described in SE 510,868. -
FIG. 18 shows the finished spacer member after casting, intended to serve as an articular head in a joint, for example a finger joint. The cast-on material has been indicated by 27 inFIG. 18 . Thenetwork structure 26 forms a hose which strengthens the spacer body from the inside, and thenetwork portion 28 protruding from thecast body 27 forms a hose portion which is intended to be engaged on a bone which is to be connected to an adjacent bone via the joint. A further purpose of the network structure, besides that of serving as a strengthening means, is to create a high degree of friction against the bone and facilitate growth therein. Thenetwork structure 26 is also stable for sewing in upon fixation to the bone. -
FIG. 19 shows, in a similar way toFIG. 17 , a knitted or otherwise formednetwork structure 29 which is intended to form an outer reinforcement for a spacer member, which is intended to serve as an articular socket, i.e. as a complement to a spacer member of the type which has been described in connection withFIGS. 17 and 18 . - The
network structure 29 is provided with one ormore securing portions 30 which are intended to be secured on the outside of a bone by means of suture thread or the like. The securingportion 30 can go all the way round or be made up of one or more securing portions. - An illustrative embodiment with two securing
portions 30 is shown in the drawing. - A degradable material, preferably in the form of polyurethanes with hydrolyzable ester groups, is cast onto the inside of the network structure, as can be seen from
FIG. 20 , for forming an articular socket. The cast-on material has been indicated by 31 inFIG. 20 . The purpose of the network structure according toFIG. 20 is the same as has been described in connection withFIG. 18 , i.e. to serve as reinforcement in the spacer member, create friction against the bone and facilitate growth in the bone. - FIGS. 17 to 21 show relatively thin spacer members corresponding to the spacer members shown in
FIGS. 13 and 15 . -
FIGS. 21 a and 21 b show a knitted or otherwise formednetwork structure 32 of the type which has been described in connection withFIG. 17 above. - The
network structure 32 differs from that shown inFIG. 17 in that the top 33 of the structure is condensed and in that the reinforcement in the top 33 has a depth which will substantially correspond to the thickness of thedegradable material 34, seeFIG. 22 , which is cast from the outside and in across the depth of the network structure in the top 33. Thecast material 34 like the network structure is expediently made of polyurethanes with hydrolyzable ester groups. - The actual spacer member in the embodiment according to
FIG. 22 has a thickness which substantially exceeds the thickness of the spacer member according toFIG. 18 . In principle, the difference arises in the same way as the difference in size which has been described in connection withFIGS. 13 and 14 above. Thenetwork structure 32 fulfils the same purposes as have been described above in connection with FIGS. 17 to 20. - However, the
network structure 32 has a substantial depth at the top 34 and in this area it will serve also as internal reinforcement in the cast-on material. It is important that the spacer member in a joint does not collapse under the pressures which arise during natural use of the joint, and instead the temporary spacer member must hold adjacent bone ends at a distance from each other. It is of course also important that the temporary spacer members are resistant to wear. - The different embodiments of the spacer members shown in FIGS. 17 to 22 are combined with a joint-stabilizing connection, for example in the form of flexible thread-like elements which have been described in connection with FIGS. 7 to 12.
- The invention is not limited to the illustrative embodiments described above, and instead it can be modified in a number of ways within the scope of the attached patent claims.
- The spacer member, which can consist of a cast or spun and thereafter knitted or woven structure or an otherwise formed structure, can be provided, as has been described above, with strengthening threads of the same material as the rest of the structure or of another degradable and tissue-compatible material.
- Said strengthening threads can be arranged to form a reinforcement skeleton which is intended to give the structure stability without locking it. The strengthening threads can for example be arranged in a defined direction in order to afford increased strength in this direction.
- The reinforcement skeleton can consist of a shell which surrounds the rest of the structure. In addition to said shell, the reinforcement structure can also comprise strengthening threads in one or more defined directions.
- In the above described embodiment have been mentioned suitable examples of materials for a degradable implant. Further examples of degradable materials for the implant in accordance with the invention are defined in the following patent claims.
- The invention is not restricted to implants of degradable materials. Examples of non-degradable materials are silicone and polyethylene terephtalate.
- The implant according to the invention can have different forms than have been described above. All corners of the in the figures schematically shown T-shaped implant are preferably rounded.
- The implant can be shaped as a plate with integrated fastening members or joint-stabilizing connections. The implant can have a sponge-like shape with integrated stabilizing connections.
- Within the scope of protection is an implant arranged such that the shape of the implant is adapted to the anatomic shape when exposed to load.
- The joint-stabilizing connection can be designed in a different way than has been described above.
- The material of the spacer member can consists of polytetrafluoro ethylene (PTFE). Also the joint-stabilizing connection can be made in the same material. This material is generally known under the trade name TEFLON®.
Claims (1)
1. Implant for reconstruction of joints, which is T-shaped in cross section and is made entirely of degradable polyurethane urea which is of one piece construction and at least partly porous.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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US11/367,386 US20060149261A1 (en) | 2001-01-15 | 2006-03-06 | Implant for reconstruction of joints |
Applications Claiming Priority (5)
Application Number | Priority Date | Filing Date | Title |
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SE0100127A SE525131C2 (en) | 2001-01-15 | 2001-01-15 | Implants for reconstruction of joints |
SE0100127-0 | 2001-01-15 | ||
US10/250,310 US7037342B2 (en) | 2001-01-15 | 2002-01-11 | Implant for reconstruction of joints |
PCT/SE2002/000038 WO2002054992A1 (en) | 2001-01-15 | 2002-01-11 | Implant for reconstruction of joints |
US11/367,386 US20060149261A1 (en) | 2001-01-15 | 2006-03-06 | Implant for reconstruction of joints |
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US10/250,310 Division US7037342B2 (en) | 2001-01-15 | 2002-01-11 | Implant for reconstruction of joints |
PCT/SE2002/000038 Division WO2002054992A1 (en) | 2001-01-15 | 2002-01-11 | Implant for reconstruction of joints |
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US20060149261A1 true US20060149261A1 (en) | 2006-07-06 |
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US11/367,386 Abandoned US20060149261A1 (en) | 2001-01-15 | 2006-03-06 | Implant for reconstruction of joints |
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US10/250,310 Expired - Fee Related US7037342B2 (en) | 2001-01-15 | 2002-01-11 | Implant for reconstruction of joints |
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US (2) | US7037342B2 (en) |
EP (1) | EP1351630B1 (en) |
JP (1) | JP4156924B2 (en) |
CN (1) | CN1248662C (en) |
AR (1) | AR032791A1 (en) |
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US20080255664A1 (en) * | 2007-04-10 | 2008-10-16 | Mdesign International | Percutaneously deliverable orthopedic joint device |
US20100106254A1 (en) * | 2008-10-23 | 2010-04-29 | Delsignore Jeanne L | Surgical implantable stabilizer sling for basal joint arthroplasty |
US20110046681A1 (en) * | 2008-10-02 | 2011-02-24 | Bernard Prandi | Orthopedic implant in the form of a plate to be fixed between two bone parts |
US20110093084A1 (en) * | 2007-02-09 | 2011-04-21 | Morton Troy N | Artificial joint preserving tendon and/or sesamoid bone structure |
US20110190887A1 (en) * | 2010-02-04 | 2011-08-04 | Shapiro Paul S | Surgical technique using a contoured allograft cartilage as a spacer of the carpo-metacarpal joint of the thumb or carpo-metatarsal joint of the toe |
US20110224790A1 (en) * | 2009-09-11 | 2011-09-15 | Articulinx, Inc. | Disc-based orthopedic devices |
US20110320005A1 (en) * | 2003-06-27 | 2011-12-29 | Rydell Mark A | System and Method for Ankle Arthroplasty |
US20120158153A1 (en) * | 2009-06-23 | 2012-06-21 | Replication Medical Inc. | Trapezium prosthesis |
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Also Published As
Publication number | Publication date |
---|---|
ES2261668T3 (en) | 2006-11-16 |
JP4156924B2 (en) | 2008-09-24 |
EP1351630A1 (en) | 2003-10-15 |
DE60210271T2 (en) | 2006-12-28 |
SE0100127D0 (en) | 2001-01-15 |
ATE321508T1 (en) | 2006-04-15 |
SE0100127L (en) | 2002-07-16 |
SE525131C2 (en) | 2004-12-07 |
WO2002054992A1 (en) | 2002-07-18 |
AR032791A1 (en) | 2003-11-26 |
EP1351630B1 (en) | 2006-03-29 |
CN1486166A (en) | 2004-03-31 |
US7037342B2 (en) | 2006-05-02 |
US20040093081A1 (en) | 2004-05-13 |
DK1351630T3 (en) | 2006-07-24 |
JP2004527274A (en) | 2004-09-09 |
DE60210271D1 (en) | 2006-05-18 |
CN1248662C (en) | 2006-04-05 |
AU2002217737B2 (en) | 2006-09-21 |
PT1351630E (en) | 2006-07-31 |
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